HomeMy WebLinkAboutSeptic Pump 6/5/20 YARMOUTH- DENNIS SEPTA-GE TREATMENT FACILITY
/ System .dentification ` �r,J
Town Pumped , i Telephone#
�-No. ' -� Street - ?4I Se7 u 1 la 7 bi//210--e
Village
Owner's Name: (2r G4 --72LGY'L.c , I
Mail Address:
(if different)
Use: Residence E` Business Name
Reason Pumped: Maintenance ___ Overflow Blockage
Pumper's Observations
Facility Septic Tank u�Cesspool Converted Cesspool
Pumped: Holding Tank Leach Facility Grease Trap
Cover within 1 foot? Yes ✓ No Back Flow? Yes — No
Gallons Pumped:e".�7)Comment:
Pumped By
Licensed Pumper: ��/�/�
Truck License No.: Date: .4//,,2-C)
Driver Name: / ,2 ��
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Signature:
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F Septage Received at Yarmouth - Dennis
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Approved by: Date: C/�/ate
Received: /�Z) Gallons Ticket# Q'd / �7C
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